RESUMO
Background The association of sub-normal vitamin D levels with respiratory tract infections in children has been a topic of interest in the recent literature. Vitamin D insufficiency has been explored as a modifiable risk factor in the management of pediatric recurrent respiratory tract infections. Methodology This hospital-based study included 108 children as cases aged six months to 15 years who were enrolled either as inpatients or outpatients with recurrent respiratory infections. In total, 55 healthy children of the same age group attending the hospital for vaccination and routine check-ups during the study period were included as controls. Venous blood specimens were collected from cases and controls to study serum 25-hydroxyvitamin D. Results The mean age of the cases and controls was 68.25 ± 40.3 months and 52.6 ± 40.9 months, respectively. Among the cases, 25% were vitamin D deficient and 75% had vitamin D insufficiency. The difference in proportions of vitamin D sufficiency status among cases and controls was statistically significant (p < 0.001). Conclusions There was a very high prevalence of vitamin D deficiency among children with recurrent respiratory infections compared to controls. The vitamin D status assessment should be included in the management of children with recurrent respiratory infections.
RESUMO
JUSTIFICATION: Severe acute malnutrition (SAM) is a major public health issue. It afflicts an estimated 8.1 million under-five children in India causing nearly 0.6 million deaths. The improved understanding of pathophysiology of SAM as well as new internationally accepted growth charts and newer modalities of integrated intervention have necessitated a relook at IAP recommendations. PROCESS: A National Consultative Meeting on Integrated Management of Severe Acute Malnutrition was held in Mumbai on 16th and 17th October, 2010. It was attended by the invited experts in the field. Extensive discussions were held as per the program. The participants were then divided into six groups for detailed discussions. The groups deliberated on various issues pertaining to the task assigned and presented recommendations of the groups in a plenary session. The participants made a list of recommendations after extensive discussions. A Writing Committee was formed and was entrusted with the task of drawing a Consensus Statement on the basis of these Recommendations. After multiple deliberations, the following Consensus Statement was adopted. OBJECTIVES: To critically evaluate the current global evidence to formulate a consensus among stakeholders regarding diagnosis and management of SAM. RECOMMENDATIONS: An integrated management of malnutrition is likely to yield more dividends. Thus, management of SAM should constitute an important component of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program. Determination of SAM on the basis of Z-scores using WHO Growth charts is considered statistically more appropriate than cut-offs based on percentage weight deficit of the median. Considering the fact that many children with SAM can be successfully managed on outpatient basis and even in the community, it is no more considered necessary to advise admission of all children with SAM to a healthcare facility. Management of SAM should not be a stand-alone program. It should integrate with community management therapeutic programs and linkages with child treatment center, district hospitals and tertiary level centers offering inpatient management for SAM and include judicious use of ready-to-use-therapeutic Food (RUTF). All sections of healthcare providers need to be trained in the integrated management of SAM.